1. Chapter 23 Acute Abdominal Pain (Generic Version) Presented by: Michael Farmer

2. Hollow, Solid, and Major Vascular Structures Hollow – – Appendix –Urinary bladder –Common bile duct –Fallopian tubes –Gallbladder –Intestines –Stomach –Uterus –Ureters Vessels –Abdominal aorta –Inferior vena cava Solid –Kidneys –Ovaries –Liver –Pancreas Spleen

3. Do You Know Where Your Guts Are? LUQ –Stomach, spleen, pancreas, Part of large intestine, kidney around back RUQ –Liver, gall bladder, part of large intestine, kidney around back LLQ –Part of large intestine, female reproductive organs RLQ –Appendix, part of the large intestine, female things

4. Organs of the Abdomen And Their Function Great table 23-2 on page 481 of your student text

5. Causes Of Abdominal Pain Mechanical forces – Stretching Inflammation – disease, injury, leak Ischemia – organ and tissue hypoxia Parietal Pain –Associated with irritation of the peritoneal lining Visceral pain – when the organ itself is involved –Difficult to localize

6. Referred Pain Pain from the ailing organ itself felt elsewhere in the body –Shared nerve pathways –Brain gets confused –Example: Gallbladder pain is often felt around the right scapula –See table 23-3 on page 482

7. Scene Size-up and Initial Assessment Threats BSI MOI or NOI Clues to patient condition LOC – AVPU/GCS Guarded position ABC’s Vomiting and positioning Shock? Severe pain Patient looks lousy

8. Hocus Focus(ed) History and Physical Examination Guarding Restless vs. quiet Inspection for obvious clues GENTLE palpation of each quadrant Palpate area of complaint last Pain elsewhere? Cardiac components?

9. Signs and Symptoms Pain and tenderness Anxiety and fear Guarded position Rapid/shallow breathing Paid pulse BP changes (orthostatic) Nausea/vomiting/diarr hea Rigid abdomen Distended abdomen Shock related s/s Signs of internal bleeding

10. Specific Conditions Pancreatitis –N/V –Tenderness/Diste ntion –Severe pain w/radiation to back and shoulders –Fever, rapid pulse, and shock if severe Cholecysitis –Sudden onset of pain middle of upper quadrants (epigastric to RUQ –Pain at night or after fish and chips –Tenderness on palpation to RUQ –Low grade fever –N/V nasty green stuff (bile)

11. Specific Conditions Intestinal Blockage –Moderate to severe pain –Constipation – sometimes days in length –N/V –Distention Hernia (Inguinal/Umbilical) –Abdominal pain after lifting –Fever –Rapid pulse –Uncomfortable, non-specific pain –Similar to obstruction

12. Specific Conditions Ulcer –Pain LUQ/Epigastric area (burning/gnawing) empty stomach/stress –N/V - maybe blood –Shock –Peritonitis Esophageal Varcies –Vomiting bright red blood –History of alcohol abuse common –Absence of pain or tenderness –SOB –Shock –Jaundice

13. Worst Case Scenario…… Abdominal Aortic Aneurysm (AAA) –History – known, Hypertension, progression –Gradual onset of lower lumbar and abdominal pain –Sudden onset of severe, constant pain described as tearing. –May radiate to lower back. Flank, or pelvis –N/V –Shock –Weak/Absent femoral/pedal pulses Bi/unilaterally –Pulsating mass if abdomen is soft –Rigid, board like abdomen if rupture/leak